Community Health Fair Request Form
Please complete the following information for us to review your community health fair request. Central Florida Black Nurses Association is composed of volunteer nurses, we will assess requests on a first come, first serve basis as our availability allows. Please submit requests at least 30 days in advance.
Name of Host Organization *
Your answer
Name of Contact Person *
Your answer
Email of Contact Person *
Your answer
Phone number of Contact Person *
Your answer
Name of Event *
Your answer
Date of Event *
MM
/
DD
/
YYYY
Start Time of Event *
Time
:
End Time of Event *
Time
:
Address of Event *
Your answer
Number of Event Participants Expected *
Your answer
Description of Event *
Your answer
CFBNA volunteer services request *
Required
Additional Comments
Your answer
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